DRG Category: 637

Mean LOS: 5.8 days

Description MEDICAL: Diabetes with CC

classification section:



Diabetes mellitus (DM) is a chronic disorder of carbohydrate, protein, and fat metabolism in which there is a discrepancy between the amount of insulin required by the body and the amount of insulin available. DM affects over 20 million people in the United States, although approximately 25% of those are underdiagnosed with the condition. More than 50 million people have what is called "prediabetes," a condition in which they have a blood glucose higher than normal but not high enough to be diagnosed with DM, and 35,000 people die from it each year. DM is classified into several categories (Table 1).

Types of Diabetes Mellitus

TYPE	DESCRIPTION
1	• Patients are dependent on insulin for prevention of hyperglycemia or ketosis • Referred to as insulin-dependent diabetes mellitus • Approximately 10%–20% of patients with DM have this type • The most serious life-threatening problem is diabetic ketoacidosis • Time of onset is usually under age 20 years • Beta cells of pancreas have insulitis (pancreatic inflammatory response) with beta cell destruction
2	• Patients are not dependent on insulin • Patients have either insulin resistance or impaired insulin secretion • Referred to as non–insulin-dependent diabetes mellitus • Most common type of DM: Approximately 80%–90% of DM patients have this type • Most serious problem is the development of hyperosmolar hyperglycemic nonketotic syndrome • Time of onset is usually over age 30 years • Beta cells have no insulitis; resistance to insulin occurs as the target cells
Gestational diabetes mellitus (GDM)	Patients develop glucose intolerance during pregnancy
Other types of diabetes	Diabetes develops secondary to other conditions, including pancreatic, hormonal, or endocrine disease and insulin resistance, or it is drug-induced
Malnutrition related diabetes mellitus	Occurs in underdeveloped countries to individuals with a history of malnutrition

The beta cells of the pancreas produce insulin and a protein called C-peptide, which are stored in the secretory granules of the beta cells and are released into the bloodstream as blood glucose levels increase. Insulin transports glucose and amino acids across the membranes of many body cells, particularly muscle and fat cells. It also increases the liver storage of glycogen, the chief carbohydrate storage material, and aids in the metabolism of triglycerides, nucleic acids, and proteins. In type 1 DM, beta cells of the pancreas have been destroyed by autoimmune processes, whereas in type 2 DM, relative insulin deficiency occurs accompanied by resistance to the actions of insulin in muscle, fat, and liver cells. Insulin resistance is associated with increased levels of free fatty acids in the blood, reduced glucose transport in muscle cells, elevated hepatic glucose production, and increased breakdown of fat.

Long-term complications such as disease of the large and small blood vessels lead to cardiovascular disease (coronary artery disease, peripheral vascular disease, hypertension), retinopathy, and renal failure. Diabetic patients also have nerve damage (neuropathy) that can affect the peripheral nerves, resulting in numbness and pain of the hands or feet.

Because diabetic patients are hyperglycemic, they are at higher risk for infection because an elevated glucose encourages bacterial growth. The combination of peripheral neuropathies with numbness of the extremities, peripheral vascular disease leading to poor tissue perfusion, and the risk for infection makes the diabetic patient prone to feet and leg ulcers.